Reducing Hypertension among African American Men: A Mobile Stress Management Intervention to Address Health Disparities

项目摘要/摘要 非裔美国男性患高血压(HTN)的比率是美国最高的。一旦确诊， 与其他人群相比，他们实现血压(BP)控制的可能性也更小。这种健康差距是 关键，因为血压升高是心血管疾病的主要可改变的危险因素。 HTN出现这种差异的一个原因是：压力。非裔美国人比白人承受更大的压力 同龄人，尤其是种族歧视的同龄人，管理这些压力源的资源较少。这种压力 会产生重大的生理后果。与白人相比，非裔美国人表现出高度的变态 负荷，一种衡量慢性激活压力生理系统的生物效应的指标。重要的是 这些系统的应激诱导激活与HTN的病因学有关。压力也会加剧HTN 通过不健康的应对(如吸烟、暴饮暴食、饮酒)和较差的降压坚持 药物。压力预测了非洲裔美国人的这些应对行为和医疗不合规。尽管 压力和HTN之间有明确的联系，英国石油公司没有定期部署压力管理来管理BP。这是一个 错失了机会，因为压力管理干预已被证明能够改善HTN。 现有的关于压力管理干预降低血压的研究大多包括White 参与者。这一点意义重大，因为行为健康计划是专门为少数群体设计的 比泛型程序更有效。由于压力极大地推动了HTN的健康差距， 为非裔美国男性开发有效的压力管理计划对于缩小这一差距至关重要。 一种经济高效、易于扩展的解决方案是mHealth。最易访问的移动格式之一是文本 消息传递。重要的是，98%的非裔美国人拥有手机。大多数是智能手机(70%)。 据我们所知，还没有开发出移动认知行为压力管理干预 非裔美国男性管理种族和非种族的压力源，以努力减少HTN差异。 我们打算填补这一空白。完成后，教育短信将增加知识，发展技能， 并减少适应性应对的障碍。支持性文本将肯定非裔美国人的生活经历 男人。一个单独定制的视频库将根据理论提供给每个用户 压力评估(包括感觉到的歧视)和应对。所有移动网络内容都将 通过嵌入在文本消息中的基于触摸的链接轻松高效地访问。 18名非洲裔美国男性将被招募参加焦点小组讨论，以告知原型 发展。当原型完成后，这18个目标最终用户将返回进行可用性测试。这个 可用性测试将包括一系列任务，旨在突出建议的 干预。将评估三个可用性指标：效率、准确性和可接受性。

PROJECT SUMMARY/ABSTRACT African American men have the highest rate of hypertension (HTN) in the United States. Once diagnosed, they are also less likely than other groups to achieve blood pressure (BP) control. This health disparity is critical, as elevated BP is the primary modifiable risk factor for cardiovascular disease. One reason for this HTN disparity: stress. African Americans experience more stress than their White peers, most notably from racial discrimination, and have fewer resources to manage these stressors. This stress has significant physiological consequences. Compared to Whites, African Americans show heightened allostatic load, a measure of the biological effects of chronically activating the stress physiological systems. Importantly, stress-induced activation of these systems is implicated in the etiology of HTN. Stress also exacerbates HTN through unhealthy coping (e.g., smoking, overeating, alcohol use) and poorer adherence to antihypertensive medications. Stress predicts these coping behaviors and medical noncompliance in African Americans. Despite clear links between stress and HTN, stress management is not regularly deployed to manage BP. This is a missed opportunity because stress management interventions have been shown to improve HTN. Existing research on stress management interventions for BP reduction included mostly White participants. This is significant because behavioral health programs designed specifically for minority groups are more effective than generic programs. Because stress significantly drives health disparities in HTN, developing effective stress management programs for African American men is vital to closing this gap. One cost-effective, easily scalable solution is mHealth. One of the most accessible mobile formats is text messaging. Importantly, 98% of African Americans own a mobile phone. Most are smartphones (70%). To our knowledge, no mobile cognitive behavioral stress management intervention has been developed for African American men to manage racial and nonracial sources of stress in an effort to reduce HTN disparities. We intend to fill this void. When completed, educational text messages will increase knowledge, develop skills, and reduce barriers to adaptive coping. Supportive texts will affirm the life experiences of African American men. A library of individually tailored videos will be delivered to each user depending on a theory-based assessment of stress (including perceived discrimination) and coping. All mobile web content will be effortlessly and efficiently accessed via touch-based links embedded within text messages. Eighteen African American men will be recruited for focus group discussions to inform prototype development. When the prototype is completed, these 18 target end-users will return for usability testing. The usability test will include a series of tasks intended to highlight the different features of the proposed intervention. Three usability metrics will be assessed: efficiency, accuracy, and acceptability.